Request for Claim Adjustment Instructions

How do I file an adjustment to a claim?

Complete a Professional or Institutional Claim Adjustment Request Form.

The following requests require medical documentation:

Procedure code changes

Diagnosis code changes

Diagnosis code pointer changes

Units of services changes

Modifier changes

The following requests do not require medical documentation:

Dollar amount changes

Additional or adjusted charges

Additional information needed to ensure timely processing:

Include the date of service and claim number of the claim which you are requesting the change.

Please give a detailed explanation of changes you are requesting.

When submitting chart notes or medical information, submit an explanation of why this information is being submitted. If the information being submitted was requested by Blue Cross Blue Shield of WY, please attach a copy of the request.